Nc’s Teepa Snow Is Teaching How To Approach Dementia Differently

By Ashley Fredde

Teepa Snow had been decently warned that “Ms. Jackson is connected a tear” by nan on-duty caregiver erstwhile she strode into nan room. 

She recalls huffing successful exasperation  and reasoning successful consequence “That’s because yall don’t cognize really to do this.” By her ain admission, arsenic a young nursing adjunct she was cocky — but not without merit. 

Snow, now 71, had worked pinch group pinch developmental disabilities arsenic a teen and passim her earlier adulthood, starting her profession successful nan basement of a church. But connected that time astir 45 years ago, she was nan first postgraduate retired of nan University of North Carolina astatine Chapel Hill’s occupational therapy program. Her liking successful geriatrics, stroke, caput wounded and developmental disablement led her to nan semipermanent attraction installation successful Henderson wherever she had met Ms. Jackson. 

Jackson was a Southern Baptist, for illustration Snow’s grandmother. Snow could singing nan hymns by heart, decorativeness nan prayers, gaffe into nan hit of a Bible’s chapters and verse. The shared knowing often worked successful her favour among her charges.

When Snow arrived astatine nan room, Jackson was opinionated successful nan doorway pinch her bedsheet wrapped astir her. Her pajamas were peeking retired beneath, and her slumber headdress was perched atop her head. In her arms she carried her belongings — a Bible successful 1 hand, a teddy carnivore tucked against her side, and a h2o pitcher — arsenic if preparing to travel. 

She caught show of Snow.

“Hey, you. Girl,” she called. “Come here. Come here. I request you to transportation maine to spot Mr. Dukes.”

Snow said her consequence past was overmuch different than it would beryllium now. She redirected Jackson toward nan bathroom, toward nan greeting routine, toward what “needed to beryllium done.” Jackson’s insistence turned into vexation that included immoderate expletives thrown astatine Snow, embellished pinch nan swift smack of nan Bible she carried. 

Staff quickly administered nan powerful anti-psychotic supplier haloperidol to subdue her. 

The adjacent day, Snow arrived to find Jackson’s room quiet — she had been admitted to nan infirmary for shingles. Realization dawned that Jackson had been asking Snow to return her to Duke Hospital, wherever Duke ran a session for indigent populations. 

“That was a large infinitesimal of appreciation — that she was trying to pass pinch maine ace clearly, and I was truthful judge I knew nan correct answer,” Snow recalled. “Ever since, early on, I person believed challenging situations hap because we group are trying to pass and we’re not bully astatine picking up connected nan communication.”

Seeing nan person, not nan disease

Decades later, Snow, now an world master trainer connected nan attraction of group pinch dementia, sees things differently.

Snow’s approach, which she would later formalize through  her Hillsborough-based Snow Approach Foundation, centers connected a elemental shift: See nan personification earlier nan diagnosis.

“People person dementia. It doesn’t diminish their humanness. It diminishes capacity successful immoderate areas, but successful different areas, they’re really quicker astatine picking up connected things that you wish they didn’t,” Snow said. “That’s wherever nan activity comes from is that belief that immoderate you person left, it’s not adjacent for maine to return things distant from you that you still person capacity for. And it turns retired group for illustration that.”

That attack is seen successful 1 of Snow’s astir wide taught methods, nan “hand-under-hand” method — which she slips into demonstrating easily. She takes clip to announcement nan person’s ascendant hand, and different preferences, earlier approaching from nan broadside and positioning herself astatine oculus level. Then she offers a manus beneath nan different person’s manus alternatively than grabbing from above. The method allows nan personification surviving pinch dementia to power nan activity and sphere autonomy. 

The hand-under-hand method is simply a portion of Snow’s training program, Positive Approach to Care, which is built astir concrete, repeatable skills that are easy learned by group who are providing attraction for group surviving pinch dementia — whether successful an institution aliases astatine location pinch a loved one. The accent is practical: not only knowing why behaviour happens, but learning really to respond differently. 

To thief group understand differences successful approach, Snow films how-to videos and examples utilizing kitchen, chamber and bath sets arranged successful different formats to mimic someone’s situation.

“When a organization is moving into this abstraction of being genuinely person-centered, erstwhile it cares astir some labor and residents and families arsenic group first … we spot nan relationships commencement to beryllium present,” Snow said. “It’s this expertise to beryllium funny astir different quality being’s preferences, needs.”

The programme puts nan attraction connected nan abilities personification pinch dementia still has alternatively of centering what has been lost. Care partners are encouraged to activity pinch nan person, alternatively of acting connected them and doing for them — shifting full interactions into collaboration. The extremity of nan attack is to trim clash and build a narration that makes regular attraction consciousness little for illustration a struggle. 

Part of that is recognizing encephalon changes successful nan personification surviving pinch dementia without reducing nan personification to nan behaviors they’re displaying, nan halfway of Snow’s GEM State Model. Instead of ranking loss, nan exemplary describes different cognitive states — Sapphire, Diamond, Emerald, Amber, Ruby and Pearl — each representing different abilities and needs. 

“Once we get patient successful relationships again pinch group surviving pinch dementia, it makes each nan quality successful nan world,” she said. “We extremity seeing them arsenic resistive to care. We extremity seeing them arsenic noncompliant, we extremity seeing group arsenic incapable — and we commencement looking for what is possible.”

A strategy not built for dementia

Each year, much families participate a strategy of attraction that Snow believes is “broken” erstwhile it comes to dementia. An estimated 7.2 cardinal older Americans are surviving pinch Alzheimer’s disease, including much than 210,000 successful North Carolina — 11.6 percent of nan state’s organization of group 65 and older, according to nan Alzheimer’s Association 2025 report. 

Another 200,000 Americans nether 65 are surviving pinch younger-onset Alzheimer’s. Deaths attributed to nan illness proceed to rise, pinch North Carolina Alzheimer’s deaths rising 147 percent betwixt 2000 and 2022, according to nan report, erstwhile nan organization of group complete 65 successful nan authorities astir doubled to just nether 2 million. 

“No matter really good you do your job, you suffer your patient. No matter really good you do this, their abilities are going to alteration connected you, nary matter really overmuch you activity pinch a family, astatine immoderate constituent that family is going to suffer them,” Snow said. “This is nan only information that I cognize astir that for sure: They will die, and there’s nary measurement retired correct now.”

Despite nan prevalence of nan diagnosis, Snow argues that nan strategy astir it is fragmented. 

“I spell successful and I find retired I person nan condition,” she said. “I’m leaving without thing different than ‘Get your affairs successful order.’”

Too often, she said, families time off aesculapian appointments without a roadworthy representation — nary phased plan, nary system education, nary network. 

“We wouldn’t do that pinch a crab patient,” she said. “How are we going to live? Are we successful a palliative mode? Are we still successful a preventive mode? What’s our crippled plan?”

With nary scheme successful place, nan load often shifts almost wholly to families. The full life costs of attraction for personification pinch dementia approaches $400,000, pinch astir 70 percent of nan costs borne by family attraction partners done unpaid labour and out-of-pocket expenses, according to nan Alzheimer’s Association. 

The Snow Approach Foundation’s organization building features a memorial character of members nan instauration worked pinch who person since died. Each plaque describes nan member’s life and accomplishments. Credit: Ashley Fredde

The nationalist median costs for in-home dementia attraction is $33 per hour, according to nan Genworth Cost of Care Survey 2024. Monthly rates scope from $2,145 for 15 hours per week to $6,292 for 40 hours per week. Location, attraction needs, and nan level of nan nonstop attraction person’s training each tin impact nan price. 

In North Carolina alone, Medicaid costs tied to dementia attraction are estimated astatine $1.8 billion, and Medicare spending averages were $28,484 per personification pinch dementia successful 2023, nan study stated. Much of that costs is for placing a dementia diligent successful a installation erstwhile their attraction becomes excessively overmuch for families. 

“We person this anticipation that families will do attraction until they can’t,” Snow said.

Families who are already reaching their breaking constituent often show up successful nan shape of a infirmary admittance aliases emergency room visit, she said. That breaking constituent isn’t because nan family doesn’t care, Snow said, but it does often exemplify that they weren’t adequately prepared. 

The caller move often reshapes relationships betwixt nan personification surviving pinch dementia and nan group Snow refers to arsenic attraction partners, whether they are children aliases partners who whitethorn besides beryllium aging. Snow believes dementia attraction must relationship for 2 changing brains.

“There should beryllium duality successful our work,” she said. “We should beryllium asking, ‘How are you doing here?’” 

One of Snow’s first directives  to attraction partners tin beryllium revealing: “‘Tell maine what you still for illustration astir nan personification you’re surviving pinch now.’ When nan reply is insistence that they emotion nan personification but nary existent reply beyond that,” she said, “we’re astatine a situation point.” 

While families are struggling, nan master workforce is experiencing a shortage that makes it ill-equipped to meet nan increasing need. In North Carolina, a 61 percent summation successful geriatricians will beryllium needed by 2050 to meet nan demand, according to nan Alzheimer’s Association. 

“Policy makers want location to beryllium a inexpensive fix, and correct now, we don’t person a scheme for caring for group surviving pinch dementia. We genuinely don’t,” Snow said. “It’s going to clang nan strategy soon because we’re going to extremity up putting them successful acute attraction situations and agelong word attraction situations that we can’t spend — and break families.”

What Snow is asking for is not a occurrence cure, she said, but honesty — and preparation.

“Please discontinue promising group what you can’t deliver,” she said. “Let’s commencement talking astir really we’re going to thief group unrecorded done this disease.”

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